Healthcare Provider Details

I. General information

NPI: 1639415953
Provider Name (Legal Business Name): SARA GALLEGOS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2012
Last Update Date: 12/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 EUBANK BLVD SE
ALBUQUERQUE NM
87123-3453
US

IV. Provider business mailing address

1408 SOMERSET DR NW
ALBUQUERQUE NM
87120-5510
US

V. Phone/Fax

Practice location:
  • Phone: 505-845-8159
  • Fax: 505-845-8667
Mailing address:
  • Phone: 505-366-4485
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WX0106X
TaxonomyOccupational Health Registered Nurse
License NumberR695J8
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: